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Appropriate use of imaging studies avoids aggressive treatment

Kenneth Bollin, M.D., St. John Family Medical Center in St. Clair Shores, makes a concerted effort to avoid imaging studies for low back pain. He believes in combining patient expectations with evidence-based care.

According to NCQA, The State of Health Care 2010, less than 1 percent of radiographs identify a specific cause of low back pain. Dr. Bollin says his practice results have shown that the patients who have had imaging studies and those with conservative treatment tend to have the same outcomes.

"At one- and six-month intervals, they all get better at about the same rate," he said. The practice sees approximately 23,000 patients a year. About 10 patients a day complain of low back pain.

Dr. Bollin explained that most injuries that cause back pain are caused by soft tissues — ligaments, tendons and discs — and not the spine. There's no benefit to an X-ray that is only going to show the bone. And even though you may see the source of back pain with an MRI, it's not treated any differently, he said.

"If the patient isn't getting better and we may have to contemplate surgical intervention, we might be able to see problem areas on an MRI or X-ray," says Dr. Bollin. "But unless we see anything unusual or see any warning flags, we try conservative treatment first," he said. Conservative treatment might include pain medication, anti-inflammatory medication and rest.

The next course of treatment may include physical therapy for four to six weeks. "If I see 100 patients with back pain and 33 have to go to physical therapy, and of those patients10 are still having problems, I have succeeded in eliminating unnecessary imaging studies," Dr. Bollin said.

The bottom line is to avoid unnecessary or aggressive treatment. While there are red flags that warrant doing imaging studies, a small percentage of patients opt for surgery or need aggressive treatment.